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Peds Exam 2 > Lecture 9: Hematology/Oncology > Flashcards

Lecture 9: Hematology/Oncology Flashcards

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1
Q

Difference b/t ALL and AML (acute leukemia)

- prevalaence + peak ages

A

ALL

  • MC (ALL kids have ALL)
  • peak 2-4 yrs

AML

  • less common
  • peak: < 2 yrs
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2
Q

What d/o incr your risk of acute leukemia

A
  1. imunodefic syndromes
  2. DNA repair/Repair Syn
  3. Down Syndrome
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3
Q

Lung, skin, and GI organ s/s of Acute Leukemia

A

Lung –> SOB

Skin –> easy bleeding/bruising, petechiae

GI organs enlarged (liver/spleen)

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4
Q

3 Main things seen on labs a/w Acute Leuknemia

What are these things d/t?
Which 2 most commonly seen on labs

A
  1. Anemia (Normocytic, normochromic)
  2. Neutropenia
  3. Thrombocytopenia
    - most have 2+3

blast cell proliferation in bone marrow –> decr production og RBCs, WBCs, Plts

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5
Q

What may be seen on PBS that is a/w Acute Leuknemia?

Seen on Tumor Lysis labs?

Seen on XR?

A

+/- circulating blast cells

incr K, Ca, P, LDH, Uric acid, Cr (d/t breakdown of leukemia cells)

+/- pleural effusions, mediastinal mass

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6
Q

What is used to determine type of leukemia/Tx? how?

A

Flow Cytometry determine type of leukemia/Tx by biological markers

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7
Q

Difference b/t Tx of ALL and AML (intensity, bone marrow transplant)

Which type is remission more common in? relapse?

A

ALL

  • less intensive induction
  • b. marrow transplant = rare
  • remission more common

AML

  • more intensive + toxic
  • b. marrow transplant = common
  • RELAPSE more common
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8
Q
  1. GH defic
  2. HL
  3. Heart damage
  4. 2nd CAs
  5. Abn bone/muscle growth
  6. infertility
  7. Cognitive defects
  8. Psych issues
  9. Low thyroid fxn
  10. Reduced lung fxn
  11. Obesity/metabolic Syn
A

Late effects of childhood CA

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9
Q

What type of lymphoma is MC?

Which is curable in most?

A

MC = NHL

Hodgkin’s Lymphoma = curable in most most

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10
Q

Difference in presentations b/t HL and NHL?

A

HL

  • central/mediastinal LNs
  • Reed Sternburg cells

NHL

  • peripheral LNs
  • Starry Sky histology
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11
Q

What is the MC S/s for brain tumors?

combo of what 2 Sxs together = more reliable for Brain tumor

Other s/s:

  1. N/V
  2. Visual Field defecit
  3. Endocrine dysfx
  4. seizure, gait abn
A

HA

HA + Neuro Sxs = more reliable for Brain tumor

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12
Q

Main imaging modality of choice for brain tumors

What would suggest marrow infiltration

Tx = surg, radiation, chemo

Do infants have good or poor prognosis?

A

MRI = best for brain tumors

bone pain or abn CBC suggests marrow infiltration

infancy = poor prognosis w/brain tumors

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13
Q

Where does neuroblastoma arise from

A

primitive neuroblasts in neural crest tissue

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14
Q

How does presentation of neuroblastoma differ before and after age 1?

A

< 1

  • tumors above diaphragm/localized
  • better prognosis

> 1

  • MC = tumor in abd
  • most has widespread dz
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15
Q

What can be seen on plain films w/neuroblastoma?

What labs are usu elevated in most pts?

A

Stripped calcifications on XR

Elevated urinary catecholamines in most pts

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16
Q

Tx of neuroblastoma:

  • low risk
  • intermed
  • high
A
  • low risk –> surgery
  • intermed –> surgery + chemo
  • high –> multimodal
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17
Q

Where is Wilm’s tumor located? MC age range? more commonly unilateral or bilateral?

A

tumor in kidneys

MC b/t 1-5 y/o

More commonly unilateral

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18
Q

MC presentation of Wilm’s tumor

Others:

  1. HTN
  2. Gross hematuria
  3. Fever
A

Asx (not painful) abd mass

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19
Q

describe constipation in Wilm’s tumor and whats seen on XR

Common lab finding?

Tx = multimodal
how long to f/u? why?

A

constipation

  • doesnt resolve w/tx
  • on XR = “shifting bowel”

Anemia

F/u for 8 yrs –> look for spread to other kidney

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20
Q

Where is osteosarcoma MC common? more specific?

age group most common in?

MC Sxs

Labs?

What is required for Dx?

A

MC at metaphysis of long bones (area of bone growth)
- distal femur = MC

MC in adolescence

Sx = Pain

HIGH AlkP + LDH

Need Bx for Dx

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21
Q

Imaging of Osetosarcoma:
- what is characteristically see on XR

  • what imaging is used for looking for METs? MC sites?
Study These Flashcards
A

XR –> sunburst rxn

MRI –>look for METS
- MC in lungs, other bones

22
Q

Why is radation therapy not used for osteosarcoma?

What are the 2 surgical Tx options?

Study These Flashcards
A

radiation wont work b/c osteosarcoma tumors are radioresistant

Surgery

  1. amputation
  2. limb sparing w/prosthesis
23
Q

What is cause of Retinoblastoma? result?

More commonly uni or bilateral?

MC before what age

Study These Flashcards
A

Heritable mutation/deletion of RB1 tumor suppressor gene –> uncontrolled tissue growth in eye

More commonly bilateral

MC before age 2

24
Q

Main Sign of Retinoblastoma?
- meaning of sign?

3 other signs?

Study These Flashcards
A

Main sign = leukocoria
- absent red reflex

  1. Strabismus
  2. Proptosis
  3. Neuro Sxs
25
3 Tx option for Retinoblastoma?
1. Radiation 2. Chemo 3. *Enucleation
26
When is retic count high? When is the retic count low?
High retics w/incr RBC destruction Low retics w/RBC production problem
27
MCV (mean cell/corpuscular volume) stands for? How is MCV in newborns? why? How to calculate norm MCV in young kids
MCV (mean cell/corpuscular volume) = avg size of the RBCs MCV is high in newborns d/t fetal Hb --> decr over couple months upper limit of norm MCV in kids = 70 + age
28
incr RBC destruction: 1. Hemoglobinopathies 2. RBC membrane defects 3. Enzyme Defects 4. immune mediated examples
1. .. 2. RBC membrane defects= Speherocytosis, Elliptocytosis, Pyropoikilocytosis 3. Enzyme Defects = G6PD or Pyruvate Kinase Defic
29
Pt has unconjugated hyperbilirubinemia, + DAT/coombs test and + maternal Ab screening and hemolysis on PBS (incr retics, macrocytosis, polychromasia) What is Dx?
Immune mediated Hemolytic Dz
30
If D antigen is present on surface of RBCs what does that tell you about the pt?
Pt is Rh+
31
in Anti-Rhesus (Rh) Dz what causes hemolytic anemia in the neonate/newborn
Maternal sensitization
32
What occurs during maternal sensitization Why is not a problem in the pregnancy that the sensitization occurs in? When is most maternal sensitization? Other time can occur?
small amts of FETAL blood transferred to MOTHER across placenta during pregnancy --> mother forms IgM Abs - not a problem b/c IgM Abs dont cross placenta --> baby not infected most in 3rd trimester - also during delivery (incr amt of fetal blood exposed to mother)
33
Why are babies of subsequent pregnancies at risk for Rh-Dz? result?
IgG Abs produced by mother --> can cross placenta --> Hemolytic Dz of the Newborn
34
What is the fetal response to maternal sensitization in susequent pregnancies? (3)
1. Fetal RBC's get coated w/maternal IgG --> erythroblastosis --> destruction of fetal RBCs 2. Anemia --> stim erythropoiesis 3. Extramed erythropoiesis--> HSM
35
How to prevent Rh-Dz and immune mediated hemolytic dz of newborn?
GIVE ALL Rh (-) women Rhogam | - anti-D immunoglobulin
36
When is Rhogam given to Rh (-) women? (2 instances) How does it work to prevent immune mediated hemolytic dz?
1. at 28 and 34 wks gestation 2. Postpartum if baby is Rh+ Fetal blood crosses placenta to mother--> Ab attaches to infant blood - mother's body destroys Ab-coated RBCs before she creates Abs to it
37
A women comes in who has had a previous maternal sensitization but not given rhogam during that pregnancy and now has Rh Abs. She is pregnant again, can you give her Rhogam? why y/n?
No | - Rhogam can only be given if mother doesnt have Abs
38
What is the predominant feature of Hemolytic Dz of newborn/ABO compatability....?
Hyperbilirubinemia in first 12 | to 24 hours of life
39
How does ABO incompatibility differ from Rh-Dz?
No prior exposure is needed w/ABO incompatability | - body automatically makes Abs to what you dont have
40
Two ways to manage hemolytic Dz of the Newborn, what are they aimed at preventing?
1. Antepartum therapy - prevent Hydrops Fetalis ( > 2 abn fetal fluid collections) 2. Postpartum therapy - prevent kernicterus (acute bilirubin encephalopathy)
41
How to prevent Hydrops Fetalis w/ antepartum therapy (2)
1. Intrauterine transfusion | 2. Early delivery
42
Elevated lab findings in Iron Deficiency Anemia?
TIBC, transferrin | everything else is LOW Ferritin, MCV, Hb, MCH, MCHC, retics, RBCs
43
MC cause of Fe defic in toddlers? what is this d/t?
inadequate dietary intake of iron | - d/t excessive cow's milk intake
44
2 Tx options for Iron deficiency anemia? Other edu/Tx? How long to treat?
1. Liquid preps - elemental iron 2. Polysaccharides prep - Niferex, Nu-Iron Edu --> NO MILK, incr dietary iron Tx til iron labs normalize then 2-3 mo after to replete stores
45
3 main causes of bleeding d/o and their assoc tests?
1. Vasoconstriction problems - no testing for 2. Primary hemostasis problems - plt count/aggreg, vWF studies 3. Secondary hemostasis problems - PT/PTT, fibrinogen
46
4 common Sxs of Bleeding d/o? Others: - hematemesis - melena - hematuria - hemoptysis
1. Bruises 2. Petechiae 3. Bleeding 4. Deep muscle + joint bleeding
47
Pt presents w/ bleeding from large vessels, subQ hematoma, Hemarthosis, Intramuscular hematoma. What type of bleeding is this?
Secondary Hemostasis bleeding
48
Presentation of Hemophilia in peds pts (5)?
1. Bleeding from circumcision 2. Prolonged bleeding w/heel stick 3. multiple, raised palpable bruises 4. Bleeding from IM inj 5. Swollen tender jionts after minor injury
49
What is peds palliative care
interdisciplinary approach w/with curative, restorative and life prolonging Tx
50
What 3 things does peds palliatvie care focus
1. relieve suffering 2. slow dz progression 3. Improve QoL

Peds Exam 2 (9 decks)

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